Robot-assisted radical cystoprostatectomy in complex surgical patients: single institution report

To evaluate the safety and feasibility of robotic-assisted radical cystoprostatectomy (RRCP) in a salvage setting for patients with a history of radiation and chemotherapy treatment, complex pelvic anatomy, and significant comorbidities.

Over a 5 month period, six patients who met these criteria underwent RRCP for urothelial carcinoma. Two of the patients had major cardiovascular disease and were previously denied an open procedure subsequently underwent chemotherapy with external beam radiation protocol. One patient had brachytherapy for prior prostate cancer, and three additional patients had neoadjuvant chemotherapy with large diverticula, measuring up to 12 cm in size. Data was collected on patient demographics, comorbidities, intraoperative parameters, and postoperative outcomes.

The mean age was 70.4 years (range 53-84 years) with an average BMI of 25.8 (23.33-28.37). All patients were male. All six RRCPs were completed without intraoperative complications or open conversion. The estimated blood loss was 296 cc (150 cc-500 cc). Four patients had pathologic pT3a disease, one patient had pT4a, and one patient had pT1 urethral squamous cell carcinoma. Four of the patients had positive nodes. All six patients had negative surgical margins. The patients were discharged within a mean of 12 days (range 7-28 days).

Robot-assisted radical cystoprostatectomy is a minimally invasive option in men with complex surgical anatomy and multiple comorbidities. Short term follow up indicates good clinical and pathologic outcome and physiologic benefit of minimally invasive surgery. However a larger cohort with long term follow up is needed to assess the oncologic efficacy of RRCP.